Objective To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P gt; 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P lt; 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (χ2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 ± 0.75) weeks in LCP group and (11.38 ± 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P lt; 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P gt; 0.05). There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups (P gt; 0.05). Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
Objective To investigate the therapeutic effect of long PHILOS locking compression plate on the proximal humerus and humeral shaft fractures. Methods From March 2005 to December 2007, 35 cases with the proximal humerus and humeral shaft fractures were treated with long PHILOS locking compression plate, including 16 males and 19 females aged 29-68 years old (average 54.5 years old). There were 34 cases of fresh and close fracture, and the time from injury to operation was 3-9 days. One case had delayed union of fracture 5 months after receiving T-plates and internal fixation with steel plate. For the proximal humerus fracture, 7 cases had 2 parts of fracture, 19 had 3 parts of fracture, and 9 had 4 parts of fracture according to Neer classification; while for the humeral shaft fracture, 3 cases were classified as A1, 5 as A2, 10 as B1, 3 as B2, 6 as B3, 7 as C1 and 1 as C3 according to AO classification. Postoperatively, Neer scoring system was employed to evaluate the function of shoulder joint and HSS scoring system was adopted to evaluate the function of elbow joint. Results All incisions healed by first intension, and 30 cases were followed up for 12-33 months (average 18.2 months). Postoperatively, 2 cases had symptoms of radial nerve paralysis, which disappeared within 3 weeks; 1 case suffered from humeral head necrosis and received the secondary operation of humeral head replacement; humeral head was reduced evenly in 1 case, and 2 cases felt chronic sl ight pain in shoulder joints and received no further treatment. X-ray films showed 29 cases had fracture heal ing 6 months after operation, and all the patients had bone union 12 months after operation except 1 case receiving humeral head replacement. No such compl ications as screw lossening and internal fixation loosening occurred. By Neer scoring system, 6 cases were graded as excellent, 19 as good, 3 as fair, 2 as poor, and the excellent and good rate was 83.3%. By HSS scoring system, 16 cases were gradedas excellent, 14 as good, and the excellent and good rate was 100%. Conclusion Applying long PHILOS locking compression plate in the treatment of the proximal humerus and humeral shaft fractures provides a sol id fixation and high satisfactory rate with minor compl ications.
Objective To evaluate the cl inical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) in the treatment of proximal humeral shaft fracture. Methods From July 2004 to April 2008, 26 patients with displaced fractures of the proximal humeral shaft were recruited, including 8 males and 18 females. Age of patients averaged 66 years old (range, 34-82 years old). According to AO classification, there were 4 cases of type A1, 2 cases of type A2, 8 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1 and 2 cases of type C2. The time from injury to surgery averaged 2 days (range, 1-5 days). There were 8 osteoporotic fractures. Results All surgical wound healed primarily, and there was no wound infection. Three patients had postoperative radial nerve neurapraxia, which recovered at 4, 6, 8 months respectively. All patients were followed up for 6-24 months with an average of 14.1 months. Radiological examination revealed bony union within 6 months in 25 cases. There was 1 delayed union which remained asymptomatic and eventually healed at 8 months with acceptable Constant-Murley score. There were 3 cases of shoulder impingement syndrome diagnosed at 3 months post-operatively. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant-Murley scoring system, there were 11 excellent, 10 good and 5 acceptable results. The excellent or good rate was 80.8%. Conclusion MIPO technique using LCP is an effective method to treat proximal humeral shaft fractures, which facil itates functional recovery of the shoulder joint. During the surgery, it is important to achieve a good fracture reduction and to avoid compl ications.
To explore the possibil ity of treating mid-distal humeral shaft fractures associated with radial nerve palsies with minimal invasive plating osteosynthesis (MIPO) techniques. Methods From April 2003 to October 2006, 10 patients with mid-distal humeral shaft fractures associated with radial nerve palsies were treated. All patients were male, aged 19-58 years. According to AO/ASIF classification, there were 4 cases of B1 type, 2 cases of B3 type, 1 case of A2 type, 1 caseof B2 type, 1 case of C3 type and 1 case of A3 type. A straight 4.5 mm dynamic compression plate was placed on the anterior aspect of humerus through two small incisions located on the anterior side of proximal and distal part of the arm. The radial nerve exploration was performed through a lateral small incision made on the fracture site. The fractures were then reduced by manual manipulation and the plate was fixated to the main fragments with 3 screws in each end of the plate. The postoperative compl ications, the bone heal ing time, and the recovery time of the radial nerve functions were recorded. The functions of the affected shoulder and elbow were assessed with UCLA and Mayo elbow performance score system respectively. Results All incision healed by first intention. Ten patients were followed up 9-36 months with an average of 15.7 months. The X-ray films showed that the union of fractures was achieved 12-16 weeks (13.6 weeks on average). The function of the radial nerves recovered completely 12-36 weeks (17.8 weeks on average) in 9 patients. The abductions of the affected shoulder were 150-170° (165° on average). The ROM of the elbows were 130-140° (135.5° on average). According to the UCLA shoulder scoring system, 9 patients achieved the excellent result and 1 patient achieved the good result. All the patients had the excellent results according to Mayo elbow performance score system. Conclusion The mid-distal humeral shaft fractures associated with radial nervepalsies can be treated with MIPO technique and the good results can be obtained.
To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.
Objective To investigate an effect of the minimally-invasive locking compression plate (LCP) under the anterior humeral approach to treat the complex humeral shaft fracture. MethodsEleven patients (6 males, 5 females; age, 3266 years) with a humeral shaft fracture were treated with the minimally-invasive LCP under the modified anterior humeral approach from March 2005 to February 2006. Five of the patients were injured in a traffic accident and the remaining 6 were wounded in a fall. All the patients had an unstable fracture. The multiple segment fracture was found in 2 patients, the obligue line fracture in 1 patient, and the long segment comminuted fracture in 8 patients, of whom the radial nerve injury was found in 1 patient, who had an emergency treatment by the loosening of the radial nerve and the internally fixing with LCP. As for the fracture site, the middle and/or the upper-part fracture of the humerus was found in6 patients, and the middle and/or lower-part fracture of the humerus was foundin 5 patients. The patients underwent the operation in the period from 48 hours to 4 days after the injuries. Results All the patients had a complete healing of their fractures 2-4 months after operation. One patient underwent the loosening of the radial nerve and the internally-fixing with LCP, and his function recovered 3 days after operation.The follow-up for 6-12 months revealed that all the patients’ function recovered. According to the Neer Scoring System for the shoulder function evaluation, 7 patients had an excellent result, 3 had a good result, and 1 had a fair result. According to the HSS Scoring System, 9 patients had an excellent result and 2 had a good result. Conclusion The minimally-invasive locking compression plate under the anterior humeral approach to treat the complex humeral shaft fracture is an effective and safe method of treating the complex humeral shaft fracture.